摘要

Pretibial myxedema (PTM) is a rare extrathyroidal manifestation of Graves' disease that requires treatment when the clinical picture is markedly evident. In addition to topical treatment with steroid ointments, there have been previous reports of subcutaneous injections of steroids. This procedure may cause nodular degeneration of the skin due to fat atrophy when standard needles are used. In the present study, we have tried a novel modality of treatment of PTM by injecting a solution of dexamethasone in the subcutaneous tissue using needles employed for mesotherapy. These needles are ≤4 mm long and deliver the medication within the dermis or the first layer of the subcutaneous fat. We have treated five patients, four with diffuse and one with elephanthiasic PTM. We utilized multiple injections of a solution of dexamethasone, lidocaine, and saline in the PTM plaque and in the pretibial area, both in the PTM plaque and in the area surrounding the lesions, once a week for three consecutive weeks. Two patients with a more severe form of PTM underwent another two cycles four to six weeks after initial treatment. Patients were studied before and after treatment by clinical assessment and ultrasound of the pretibial skin. The treatment was well-tolerated, with only moderate pain upon injection of the solution. One month after treatment, all patients showed improvement of PTM at clinical assessment and a reduction of the thickness of the lesions at ultrasound of ∼15%, involving mostly the dermis. Moreover, all patients reported amelioration of the leg appearance. The present study, although preliminary, shows that intralesion steroid injection with mesotherapy needles in PTM is effective and well tolerated, and does not cause undesired long-term modifications of the skin. More studies are warranted to standardize such treatment in larger groups of patients.

译文

胫前粘液性水肿 (PTM) 是一种罕见的 graves 病甲状腺外表现,当临床表现明显时需要治疗。除了用类固醇软膏局部治疗,以前也有皮下注射类固醇的报道。当使用标准针时,由于脂肪萎缩,该程序可能会导致皮肤结节性变性。在目前的研究中,我们尝试了一种新的治疗 PTM 的方法,通过使用用于美拉疗法的针头在皮下组织中注射地塞米松溶液。这些针长度 ≤ 4 毫米,将药物输送到真皮或皮下脂肪的第一层。我们已经治疗了五名患者,四名为弥漫性,一名为象皮病 PTM。我们在 PTM 斑块和胫骨前区域,无论是在 PTM 斑块还是在病变周围区域,都使用了多次注射地塞米松、利多卡因和生理盐水的溶液, 连续三周每周一次。两名 PTM 形式更严重的患者在初始治疗后 4 到 6 周接受了另外两个周期。通过临床评估和胫前皮肤超声对患者进行治疗前后的研究。该治疗耐受性良好,注射该溶液后仅伴有中度疼痛。治疗一个月后,所有患者在临床评估时显示 PTM 有所改善,在超声检查时病变厚度减少了 15%,主要涉及真皮。此外,所有患者都报告了腿部外观的改善。目前的研究,虽然是初步的,但表明在 PTM 中用美塑疗法针进行注射类固醇是有效的,并且耐受性良好,不会引起皮肤不希望的长期改变。需要更多的研究来规范更大群体患者的治疗。

Myxedema

内分泌 甲状腺 疾病
概述  :  

粘液性水肿是指粘多糖在真皮中的沉积,导致患处肿胀。下肢发生粘液水肿的一种表现是胫前粘液水肿,这是Graves病的标志,Graves病是甲状腺机能亢进的一种自身免疫形式。桥本甲状腺炎和其他长期存在的甲状腺功能减退症也可能发生粘液水肿。已知粘液水肿以多种形式的甲状腺功能亢进症发生,包括Graves病。 Graves病的标志之一是胫前粘膜水肿,下肢粘膜水肿。女性比男性更常见粘液性水肿。 病理机制 成纤维细胞刺激。认为甲状腺刺激激素(TSH)受体

Myxedema   英 /,mɪksə'diːmə/   美 /,mɪksɪ'dimə/

释    义   n. 黏液腺瘤,黏液水肿

例    句   Objective To summarize the features of myxedema coma complicated with operations on the sella tumors, and discuss the preoperative prevention and clinic treatment.目的探讨鞍区肿瘤术后并发急性黏液水肿性昏迷的特点,提出术前预防及昏迷抢救治疗方案。

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